Ultrasound provides little value to patients experiencing breast pain who have had a negative mammogram

After a negative mammogram, additional ultrasound for patients experiencing breast pain is unlikely to provide value, according to a study published by Current Problems in Diagnostic Radiology. If additional symptoms are present, however, ultrasound may be worth considering.

The authors reviewed data from more than 8,000 patients who underwent ultrasound examinations for breast pain in 2013, finding more than 500 patients who had a mammogram before the ultrasound. Breast pain, or mastalgia, was the lone symptom for more than 66 percent of patients.

Overall, no malignant findings were reported for any of the patients being treated for breast pain alone. For patients with additional symptoms besides breast pain, however, malignancies were present in two patients: one with nipple discharge and one with palpable concern.

“We identified that among 559 patients with breast pain, 2 patients (0.4 percent) were diagnosed with a malignancy, which is similar to other prior reported findings,” wrote lead author Eralda Mema, MD, department of radiology at Columba University Medical Center in New York City, and colleagues. “Importantly, all patients with a malignancy presented with an additional symptom such as palpable mass, nipple discharge, or skin changes. Among patients with breast pain, no additional symptoms and a negative mammogram, no malignancies were identified. As such, implementation of ultrasound did not unveil any mammographically occult cancers.”

Mema et al. noted that ultrasound continues to be used in addition to mammography when evaluating breast pain, though there is “no empirical evidence suggesting the additional benefit of ultrasound.”

“Review of available literature does not indicate greater identification of cancers with the addition of ultrasound in patients with mastalgia,” the authors wrote. “In these patients, additional imaging has led to clinical overutilization and further follow-ups without providing increased reassurance rates.”